1
|
Zhang K, Xi J, Zhao H, Wang Y, Xue J, Liang N, Wei Z. A dual-functional microfluidic chip for guiding personalized lung cancer medicine: combining EGFR mutation detection and organoid-based drug response test. LAB ON A CHIP 2024; 24:1762-1774. [PMID: 38352981 DOI: 10.1039/d3lc00974b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Many efforts have been paid to advance the effectiveness of personalized medicine for lung cancer patients. Sequencing-based molecular diagnosis of EGFR mutations has been widely used to guide the selection of anti-lung-cancer drugs. Organoid-based assays have also been developed to ex vivo test individual responses to anti-lung-cancer drugs. After addressing several technical difficulties, a new combined strategy, in which anti-cancer medicines are first selected based on molecular diagnosis and then ex vivo tested on organoids, has been realized in a single dual-functional microfluidic chip. A DNA-based nanoruler has been developed to detect the existence of EGFR mutations and shrink the detection period from weeks to hours, compared with sequencing. The employment of the DNA-based nanoruler creates a possibility to purposively test anti-cancer drugs, either EGFR-TKIs or chemotherapy drugs, not both, on limited amounts of organoids. Moreover, a DNA-based nanosensor has been developed to recognize intracellular ATP variation without harming cell viability, realizing in situ monitoring of the whole course growth status of organoids for on-chip drug response test. The dual-functional microfluidic chip was validated by both cell lines and clinical samples from lung cancer patients. Furthermore, based on the dual-functional microfluidic chip, a fully automated system has been developed to span the divide between experimental procedures and therapeutic approaches. This study constitutes a novel way of combining EGFR mutation detection and organoid-based drug response test on an individual patient for guiding personalized lung cancer medicine.
Collapse
Affiliation(s)
- Kexin Zhang
- Department of Biomedical Engineering, School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China.
| | - Jiyu Xi
- Department of Biomedical Engineering, School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China.
| | - Huiting Zhao
- Department of Biomedical Engineering, School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China.
| | - Yadong Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jianchao Xue
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Naixin Liang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Zewen Wei
- Department of Biomedical Engineering, School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China.
| |
Collapse
|
2
|
Gijtenbeek RG, de Jong K, Venmans BJ, van Vollenhoven FH, Ten Brinke A, Van der Wekken AJ, van Geffen WH. Best first-line therapy for people with advanced non-small cell lung cancer, performance status 2 without a targetable mutation or with an unknown mutation status. Cochrane Database Syst Rev 2023; 7:CD013382. [PMID: 37419867 PMCID: PMC10327404 DOI: 10.1002/14651858.cd013382.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND Most people who are newly diagnosed with non-small cell lung cancer (NSCLC) have advanced disease. For these people, survival is determined by various patient- and tumor-related factors, of which the performance status (PS) is the most important prognostic factor. People with PS 0 or 1 are usually treated with systemic therapies, whereas people with PS 3 or 4 most often receive supportive care. However, treatment for people with PS 2 without a targetable mutation remains unclear. Historically, people with a PS 2 cancer are frequently excluded from (important) clinical trials because of poorer outcomes and increased toxicity. We aim to address this knowledge gap, as this group of people represents a significant proportion (20% to 30%) of the total population with newly diagnosed lung cancer. OBJECTIVES To identify the best first-line therapy for advanced lung cancer in people with performance status 2 without a targetable mutation or with an unknown mutation status. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 17 June 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared different chemotherapy (with or without angiogenesis inhibitor) or immunotherapy regimens, specifically designed for people with PS 2 only or studies including a subgroup of these people. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall survival (OS), 2. health-related quality of life (HRQoL), and 3. toxicity/adverse events. Our secondary outcomes were 4. tumor response rate, 5. progression-free survival, and 6. survival rates at six and 12 months' treatment. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 22 trials in this review and identified one ongoing trial. Twenty studies compared chemotherapy with different regimens, of which 11 compared non-platinum therapy (monotherapy or doublet) versus platinum doublet. We found no studies comparing best supportive care with chemotherapy and only two abstracts analyzing chemotherapy versus immunotherapy. We found that platinum doublet therapy showed superior OS compared to non-platinum therapy (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.57 to 0.78; 7 trials, 697 participants; moderate-certainty evidence). There were no differences in six-month survival rates (risk ratio [RR] 1.00, 95% CI 0.72 to 1.41; 6 trials, 632 participants; moderate-certainty evidence), whereas 12-month survival rates were improved for treatment with platinum doublet therapy (RR 0.92, 95% CI 0.87 to 0.97; 11 trials, 1567 participants; moderate-certainty evidence). PFS and tumor response rate were also better for people treated with platinum doublet therapy, with moderate-certainty evidence (PFS: HR 0.57, 95% CI 0.42 to 0.77; 5 trials, 487 participants; tumor response rate: RR 2.25, 95% CI 1.67 to 3.05; 9 trials, 964 participants). When analyzing toxicity rates, we found that platinum doublet therapy increased grade 3 to 5 hematologic toxicities, all with low-certainty evidence (anemia: RR 1.98, 95% CI 1.00 to 3.92; neutropenia: RR 2.75, 95% CI 1.30 to 5.82; thrombocytopenia: RR 3.96, 95% CI 1.73 to 9.06; all 8 trials, 935 participants). Only four trials reported HRQoL data; however, the methodology was different per trial and we were unable to perform a meta-analysis. Although evidence is limited, there were no differences in 12-month survival rates or tumor response rates between carboplatin and cisplatin regimens. With an indirect comparison, carboplatin seemed to have better 12-month survival rates than cisplatin compared to non-platinum therapy. The assessment of the efficacy of immunotherapy in people with PS 2 was limited. There might be a place for single-agent immunotherapy, but the data provided by the included studies did not encourage the use of double-agent immunotherapy. AUTHORS' CONCLUSIONS This review showed that as a first-line treatment for people with PS 2 with advanced NSCLC, platinum doublet therapy seems to be preferred over non-platinum therapy, with a higher response rate, PFS, and OS. Although the risk for grade 3 to 5 hematologic toxicity is higher, these events are often relatively mild and easy to treat. Since trials using checkpoint inhibitors in people with PS 2 are scarce, we identified an important knowledge gap regarding their role in people with advanced NSCLC and PS 2.
Collapse
Affiliation(s)
- Rolof Gp Gijtenbeek
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Kim de Jong
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Ben Jw Venmans
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | | | - Anneke Ten Brinke
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Anthonie J Van der Wekken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wouter H van Geffen
- Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| |
Collapse
|
3
|
Cho YJ, Cho YM, Kim SH, Shin KH, Jung ST, Kim HS. Clinical analysis of patients with skeletal metastasis of lung cancer. BMC Cancer 2019; 19:303. [PMID: 30943924 PMCID: PMC6446278 DOI: 10.1186/s12885-019-5534-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/27/2019] [Indexed: 12/22/2022] Open
Abstract
Background Many factors influence bone metastases of lung cancer, and several studies report about survival of skeletal metastasis. However, few studies have focused on identifying the prognostic factors for skeletal metastasis of lung cancer, especially following orthopedic surgery. We conducted a retrospective analysis of the clinical characteristics of skeletal metastasis from lung cancer and discuss the prognostic factors. Methods We performed a medical record review of 202 patients who were diagnosed with skeletal metastasis from lung cancer. Adenocarcinoma was found in 116 patients (57.4%), squamous cell carcinoma in 29 (14.4%), small-cell lung cancer (SCLC) in 37 (18.7%), and large-cell carcinoma and other types of cancer in 20 patients (9.9%). Orthopedic surgery for skeletal metastasis was performed in 41 patients (20.3%). Results Lung cancer survival was 12.1 months. After diagnosis of lung cancer, skeletal metastasis was found at a mean of 2.5 months, and skeletal metastasis survival was 9.8 months. Lung cancer survival in patients younger than 60 years was 13.8 months, and lung cancer survival in patients 60 years or older was 10.8 months (p = 0.009). Skeletal metastasis survival in patients younger than 60 years was 11.0 months, and skeletal metastasis survival in patients 60 years or older was 8.8 months (p = 0.002). Mean skeletal metastasis survival with surgery was 12.6 months and without surgery was 9.1 months (p < 0.000). In the multivariate analysis of lung cancer survival, age under 60 years [HR (95% CI) 1.549 (1.122–2.139), p = 0.008], non-small cell lung cancer pathology type [HR (95% CI) 1.711 (1.157–2.532), p = 0.008], chemotherapy for skeletal metastasis [HR (95% CI) 8.064 (3.981–16.332), p < 0.000], and radiation therapy for skeletal metastasis [HR (95% CI) 1.791 (1.170–2.742), p = 0.007] were significant, independent, good prognostic factors. In the multivariate analysis of skeletal metastasis survival, age under 60 years [HR (95% CI) 1.549 (1.124–2.134), p = 0.007], non-small cell lung cancer pathology type [HR (95% CI) 2.045 (1.373–3.047), p < 0.000], chemotherapy for skeletal metastasis [HR (95% CI) 7.121 (3.542–14.317), p < 0.000], and orthopedic surgical treatment for skeletal metastasis [HR (95% CI) 1.710 (1.148–2.547), p = 0.008] were significant, independent, good prognostic factors. Conclusions Patients who survived longer were less than 60 years old, received chemotherapy as treatment for skeletal metastasis, had NSCLC rather than SCLC, and underwent orthopedic surgery for skeletal metastasis.
Collapse
Affiliation(s)
- Yong Jin Cho
- Department of Orthopedic Surgery, Chosun University College of Medicine, Gwangju, South Korea
| | - Yung Min Cho
- Department of Orthopedic Surgery, Chosun University College of Medicine, Gwangju, South Korea
| | - Sung Hyun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoo-Ho Shin
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Taek Jung
- Department of Orthopedic Surgery, Chonnam National University College of Medicine, Gwangju, South Korea
| | - Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchondong, Seodaemun-gu, Seoul, 120-752, South Korea.
| |
Collapse
|
4
|
Guetz S, Tufman A, von Pawel J, Rittmeyer A, Borgmeier A, Ferré P, Edlich B, Huber RM. Metronomic treatment of advanced non-small-cell lung cancer with daily oral vinorelbine - a Phase I trial. Onco Targets Ther 2017; 10:1081-1089. [PMID: 28260922 PMCID: PMC5328303 DOI: 10.2147/ott.s122106] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Micro-abstract In a Phase I dose-finding study of metronomic daily oral vinorelbine in advanced non-small-cell lung cancer, a recommended dose was established for this therapeutic approach. In addition, this trial revealed promising efficacy data and an acceptable tolerability profile. The observed vinorelbine blood concentrations suggest continuous anti-angiogenic coverage. Introduction We present a Phase I dose-finding study investigating metronomic daily oral vinorelbine (Navelbine® Oral, NVBo) in advanced non-small-cell lung cancer (NSCLC). Patients and methods Patients with stage III/IV NSCLC received daily NVBo at fixed dose levels of 20–50 mg/d for 21 days of each 4-week cycle. Primary end point was the maximum tolerated dose. Secondary end points included tumor response, time to progression (TTP), overall survival (OS) and tolerability. Results Twenty-seven patients with advanced NSCLC were enrolled. Most of them were extensively pretreated. Daily NVBo was well tolerated up to 30 mg/d. At 40 mg/d, two of five patients experienced dose-limiting toxicities (DLTs). Three of six patients had DLTs at the 50 mg/d level. The recommended dose was established at 30 mg/d in cycle 1, with escalation to 40 mg/d in cycle 2, if tolerated. Pharmacokinetic analyses showed continuous blood exposure over 21 days and only marginal accumulation. The tolerability profile was acceptable (all dose levels – all grades: decreased appetite 33%, diarrhea 33%, leukopenia 33%, nausea 30%, vomiting 26%; ≥grade 3: leukopenia 30%, lymphopenia 19%, neutropenia 19%, febrile neutropenia 15%). Disease control rate, OS and TTP signaled a treatment effect. Conclusion Daily metronomic NVBo therapy in extensively pretreated patients with advanced NSCLC is feasible and safe at the recommended dose of 30 mg/d. Escalation to 40 mg/d in the second cycle is possible. The blood concentrations of vinorelbine after daily metronomic dosing reached lower peaks than intravenous or oral conventional dosing. Blood concentrations were consistent with anti-angiogenic or immune modulating pharmacologic properties of vinorelbine. Further studies are warranted to evaluate the safety and efficacy of this novel approach in specific patient populations.
Collapse
Affiliation(s)
| | - Amanda Tufman
- University Hospital Munich and Thoracic Oncology Centre Munich, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (DZL CPC-M), Munich
| | | | | | - Astrid Borgmeier
- University Hospital Munich and Thoracic Oncology Centre Munich, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (DZL CPC-M), Munich
| | - Pierre Ferré
- Pierre Fabre Pharmaceuticals, Oncology Research and Development Center, Toulouse, France
| | | | - Rudolf Maria Huber
- University Hospital Munich and Thoracic Oncology Centre Munich, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (DZL CPC-M), Munich
| |
Collapse
|
5
|
Jia Y, Zhou D, Jia Q, Ying Y, Chen S. Synergistic and attenuated effect of HSS in combination treatment with docetaxel plus cisplatin in human non-small-cell lung SPC-A-1 tumor xenograft. Biomed Pharmacother 2016; 79:27-34. [DOI: 10.1016/j.biopha.2016.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/31/2016] [Accepted: 01/31/2016] [Indexed: 02/01/2023] Open
|
6
|
Bronte G, Rolfo C, Passiglia F, Rizzo S, Gil-Bazo I, Fiorentino E, Cajozzo M, Van Meerbeeck JP, Lequaglie C, Santini D, Pauwels P, Russo A. What can platinum offer yet in the treatment of PS2 NSCLC patients? A systematic review and meta-analysis. Crit Rev Oncol Hematol 2015; 95:306-17. [DOI: 10.1016/j.critrevonc.2015.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/12/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022] Open
|
7
|
Zarogoulidis K, Zarogoulidis P, Darwiche K, Boutsikou E, Machairiotis N, Tsakiridis K, Katsikogiannis N, Kougioumtzi I, Karapantzos I, Huang H, Spyratos D. Treatment of non-small cell lung cancer (NSCLC). J Thorac Dis 2014; 5 Suppl 4:S389-96. [PMID: 24102012 DOI: 10.3978/j.issn.2072-1439.2013.07.10] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 01/24/2023]
Abstract
Radical surgery is the standard of care for fit stage I non-small cell lung cancer (NSCLC) patients. Adjuvant treatment should be offered only as part of an investigation trial. Stage II and IIIA adjuvant cisplatin-based chemotherapy remains the gold standard for completely resected NSCLC tumors. Additionally radiotherapy should be offered in patients with N2 lymph nodes. In advanced stage IIIB/IV or inoperable NSCLC pts, a multidisciplinary treatment should be offered consisted of 4 cycles of cisplatin-based chemotherapy plus a 3(rd) generation cytotoxic agent or a cytostatic (anti-EGFR, anti-VEGFR) drug.
Collapse
Affiliation(s)
- Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Mörth C, Valachis A. Single-agent versus combination chemotherapy as first-line treatment for patients with advanced non-small cell lung cancer and performance status 2: A literature-based meta-analysis of randomized studies. Lung Cancer 2014; 84:209-14. [DOI: 10.1016/j.lungcan.2014.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/01/2014] [Accepted: 03/10/2014] [Indexed: 11/15/2022]
|
9
|
Valutazione economica in base allo studio NAVoTRIAL01 con riferimento al contesto sanitario italiano: Vinorelbine orale e Cisplatino o Pemetrexed e Cisplatino seguiti da mantenimento rispettivamente con Vinorelbine orale e Pemetrexed nel trattamento del Carcinoma Polmonare Non a Piccole Cellule Non Squamoso (NS-NSCLC) in stadio avanzato. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s40276-014-0019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
10
|
Reinmuth N, Meyer A, Hartwigsen D, Schaeper C, Huebner G, Skock-Lober R, Bier A, Gerecke U, Held CP, Reck M. Randomized, double-blind phase II study to compare nitroglycerin plus oral vinorelbine plus cisplatin with oral vinorelbine plus cisplatin alone in patients with stage IIIB/IV non-small cell lung cancer (NSCLC). Lung Cancer 2014; 83:363-8. [PMID: 24462464 DOI: 10.1016/j.lungcan.2014.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/20/2013] [Accepted: 01/01/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Adding nitroglycerin to the combination of vinorelbine plus cisplatin has been reported to improve the overall survival (OS) of Asian patients with stage IIIB/IV non-small cell lung cancer (NSCLC) probably due to better drug delivery based on changed vascular tonus. The main objective of our study was to evaluate the effect of adding nitroglycerin to vinorelbine and cisplatin in a Caucasian population. METHODS 66 chemonaïve patients with stage IIIB/IV NSCLC received oral vinorelbine (first cycle 60 mg/m(2), subsequent cycles: 80 mg/m(2) in the absence of any hematological toxicity ≥ grade 3 in cycle 1) once daily on days 1 and 8 of each cycle and cisplatin (80 mg/m(2) i.v.) on day 1 of each cycle (q3w). Nitroglycerin (arm A, n=34) or placebo patches (arm B, n=32) were administered once daily from day -3 to day 2 of each cycle and were removed about 12h after administration. One nitroglycerin patch contained 25mg nitroglycerin. RESULTS Median age was 62.5 (33-82) years. In the overall population (n=66), the objective response rate (ORR) was 27.3% (all PR; 95%CI: 17.0-39.6), with a disease control rate (DCR) of 57.6% (95%CI: 44.8-69.7), a median time to progression (TTP) of 4.8 months (n=58; 95%CI: 3.4-5.9) and a median overall survival (OS) of 11.5 months (95%CI: 7.9-13.6). ORR and DCR were numerically higher in arm A than in arm B (35.3% vs. 18.8% and 61.8% vs. 53.1%, respectively), whereas TTP and OS were comparable. The main hematological and non-hematological toxicities grade ≥ 3 were moderate with no significant differences between the two treatment arms. CONCLUSIONS Overall, oral vinorelbine plus cisplatin showed a high level of efficacy and adequate tolerability in first line treatment of NSCLC. Despite the low sample size per group the results seem to confirm the previous results reported in Asian patients.
Collapse
Affiliation(s)
- N Reinmuth
- LungenClinic Grosshansdorf, Department of Thoracic Oncology, member of the German Center for Lung Research, Grosshansdorf, Germany
| | - A Meyer
- Kliniken Maria Hilf, Pneumology, Moenchengladbach, Germany
| | - D Hartwigsen
- Malteser Krankenhaus St. Franziskus, Internal Medicine, Flensburg, Germany
| | - C Schaeper
- Universitaetsklinikum, Internal Medicine, Greifswald, Germany
| | - G Huebner
- Sana Kliniken Ostholstein, Internal Medicine, Oldenburg, Germany
| | | | - A Bier
- Universitaetsklinikum, Pneumology, Rostock, Germany
| | - U Gerecke
- Hanse-Klinikum, Oncology, Stralsund, Germany
| | - C-P Held
- Gesellschaft für medizinische Innovation Hämatologie und Onkologie mbH, Berlin, Germany
| | - M Reck
- LungenClinic Grosshansdorf, Department of Thoracic Oncology, member of the German Center for Lung Research, Grosshansdorf, Germany.
| |
Collapse
|
11
|
Li Y, Zhao X, Zu Y, Han X, Ge Y, Wang W, Yu X. A Novel Active Targeting Preparation, Vinorelbine Tartrate (VLBT) Encapsulated by Folate-Conjugated Bovine Serum Albumin (BSA) Nanoparticles: Preparation, Characterization and in Vitro Release Study. MATERIALS 2012. [PMCID: PMC5448996 DOI: 10.3390/ma5112403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vinorelbine tartrate (VLBT), as a kind of high hydrophilic and temperature-induced degradation drug, was prepared into nanoparticles by a desolvation procedure. Bovine serum albumin (BSA), as a drug carrier, was stabilized by chemical cross-linking with glutaraldehyde. Firstly, the optimization process of preparing VLBT-loaded BSA nanoparticles (VLBT-BSANPs) was accomplished using response surface methodology (RSM) by desolvation. Then VLBT-BSANPs were conjugated with folate, namely Fa-BSANPs-VLBT. Hence targeting drug carrier delivery system loading VLBT was produced. In this study, the characteristics of the nanoparticles, such as the amount of folate conjugation, surface morphology, surface chemistry, physical status of VLBT in Fa-BSANPs-VLBT, stability of Fa-BSANPs-VLBT with mannitol and in vitro drug release behavior were all investigated. The VLBT-BSANPs were obtained under optimum conditions, with a mean particle size (MPS) of 155.4 nm and a zeta potential (ZP) of −32.97 mV at a pH value of 5.4. Drug loading efficiency (DLE) and drug entrapment efficiency (DEE) of this obtained drug were approximately 45.6% and 90.6%, respectively.
Collapse
Affiliation(s)
| | | | - Yuangang Zu
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +86-451-82191517; Fax: +86-451-82102082
| | | | | | | | | |
Collapse
|
12
|
Hida N, Okamoto H, Misumi Y, Sato A, Ishii M, Kashizaki F, Shimokawa T, Shimizu T, Watanabe K. A phase I trial of concurrent chemoradiotherapy with non-split administration of docetaxel and cisplatin for dry stage III non-small-cell lung cancer (JCOG9901DI). Cancer Chemother Pharmacol 2012; 69:1625-31. [PMID: 22565592 PMCID: PMC3362714 DOI: 10.1007/s00280-012-1871-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 04/19/2012] [Indexed: 12/03/2022]
Abstract
PURPOSE This study aimed to establish the maximum tolerated dose of concurrent chemoradiotherapy (cCRT) with conventional administration of the docetaxel (D) plus cisplatin (P) (conv-DP) regimen. METHODS Patients (aged ≤70 years) with unresectable dry stage III non-small-cell lung cancer (NSCLC) and having performance status 0 or 1 and adequate organ function were eligible. They received radiotherapy (60 Gy in 30 fractions) once daily starting on day 2. Concurrent P (day 1; 60 mg/m(2) at Levels 1-3, 80 mg/m(2) at Level 4) and D (day 1; 30 mg/m(2) at Level 1, 40 mg/m(2) at Level 2, 50 mg/m(2) at Levels 3-4) were administered every 4 weeks for 2-4 courses. RESULTS Eighteen patients were enrolled (stage IIIA/IIIB, 5/13 patients). Three cases of dose-limiting toxicity were observed in this study, although another 3 cases were added at Levels 2 and 3. Radiotherapy was completed in 15 patients. Seventeen patients received more than 2 courses of chemotherapy. Neither Grade 3/4 esophagitis nor severe hematological events were observed at Levels 1-4. However, dose escalation to Level 5 (P [80 mg/m(2)], D [60 mg/m(2)]) was stopped because the Level 5 dose was the recommended dose (RD) of chemotherapy alone for stage IIIB/IV NSCLC in Japan. Therefore, the RD was determined as D50/P80 mg/m(2) in this cCRT. The objective response rate was 89%, and the median survival time was 23.6 months. CONCLUSIONS cCRT with non-split DP was a tolerable and effective regimen, and RD was 50/80 mg/m(2) every 4 weeks.
Collapse
Affiliation(s)
- Naoya Hida
- Department of Respiratory Medicine and Medical Oncology, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-Ku, Yokohama, Kanagawa, 240-8555, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Giroux Leprieur E, Lavole A, Ruppert AM, Gounant V, Wislez M, Cadranel J, Milleron B. Factors associated with long-term survival of patients with advanced non-small cell lung cancer. Respirology 2012; 17:134-42. [PMID: 21943088 DOI: 10.1111/j.1440-1843.2011.02070.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Only a small proportion of patients with advanced non-small cell lung cancer (NSCLC) have a life expectancy greater than 2 years. The aim of this study was to identify the factors associated with long-term survival of patients with advanced NSCLC. METHODS Patients who had received chemotherapy for stage IIIb or IV NSCLC that was not amenable to radiotherapy were studied retrospectively. Data were gathered prospectively from a comprehensive database. Long-term survivors (>2 years) were compared with the other patients, with respect to clinical, biological and tumour-node-metastasis criteria. RESULTS Data for 245 consecutive patients were collected. Thirty nine patients (15.9%) survived for more than 2 years. Long-term survivors were more likely to have had metastases at fewer sites (P = 0.008), an absence of bone metastases (P = 0.01), a performance status (PS) of 0-1 at first progression of the tumour (P = 0.002), a tumour that was controlled with first (P < 0.0001) and second-line (P = 0.004) chemotherapy, maintenance therapy (P = 0.001), curative surgery (P < 0.0001), time to first progression of the tumour of >3 months (P < 0.0001), normal LDH levels at diagnosis (P = 0.049), and a haemoglobin concentration >110 g/L at first progression of the tumour (P = 0.02). In multivariate analysis, surgery, maintenance treatment, time to first progression of the tumour of >3 months, a PS of 0-1 at first progression, the number of chemotherapy agents received, and LDH levels, were significant predictors of long-term survival. CONCLUSIONS Assessment of these factors, and the use of maintenance therapy, when possible, may identify a population of patients with NSCLC that is likely to have a prolonged life expectancy.
Collapse
Affiliation(s)
- Etienne Giroux Leprieur
- Thoracic Oncology Unit, Respiratory Diseases Department, Tenon Hospital, APHP and Paris VI University, Paris.
| | | | | | | | | | | | | |
Collapse
|
14
|
Carles J, Nogue M, Sole JM, Foro P, Domenech M, Suarez M, Gallardo E, García D, Ferrer F, Gelabert-Mas A, Gayo J, Fabregat X. Phase II Study of Vinorelbine and Estramustine in Combination With Conformational Radiotherapy for Patients With High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2010; 76:1085-91. [DOI: 10.1016/j.ijrobp.2009.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 03/02/2009] [Accepted: 03/03/2009] [Indexed: 11/24/2022]
|
15
|
Longs survivants de cancers bronchiques non à petites cellules stades IIIB-IV. Caractéristiques et facteurs pronostiques à partir d’une série rétrospective. Rev Mal Respir 2009; 26:952-60. [DOI: 10.1016/s0761-8425(09)73330-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
16
|
Expósito J, Hernández J, Fernández Feijóo A, Nieto T, Briones E. New chemotherapy treatments in advanced cancer patients: an easily applicable evaluation of clinical efficacy and cost-effectiveness. Acta Oncol 2009; 42:895-902. [PMID: 14968950 DOI: 10.1080/02841860310018981] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Novel cytostatic drugs have recently been introduced to treat advanced cancer patients. Although of only modest efficacy, their use is widespread, considerably increasing treatment costs. An easily applicable method to assess their efficacy and cost-effectiveness is needed. We have documented new cytostatic drugs whose consumption increased by over 60% from January 1998 to December 2000 in patients with advanced or metastatic cancer of the colorectum, lung (non-small cell), breast, ovary or brain. A review of the literature yielded 17 treatments that included these agents. For each regimen, we recorded six efficacy variables [median survival time (MS), survival rate at 1 year, absolute risk reduction, time to progression, quality of life (QoL), and patients needed to treat (NNT)]. A four-point (A-D) efficacy (E) scale and a five-point (1-5) strength of evidence (SE) scale were applied. We obtained the cost differential of each regimen for a 4-week treatment, cost per extra month of MS. and cost per NNT. One combination was rated with A efficacy (MS > 9 months+improved QoL) and nine with D (no MS or QoL improvement); 12 studies presented good quality (grade 1-2) evidence. The QoL of patients was significantly improved in only two regimens. The average cost differential was 1 311 Euro (all new regimens except one showed higher cost); the average cost per extra month of MS was 6 415 Euro; and treatment cost per NNT was 87 767 Euro. Our method proved to be easy to apply, enabled comparisons with other treatments to be made and revealed that these very costly changes in clinical practice are not justified by available studies.
Collapse
Affiliation(s)
- José Expósito
- Department of Health Management, Virgen de las Nieves University Hospital, Granada, Spain.
| | | | | | | | | |
Collapse
|
17
|
Langer CJ. The "lazarus response" in treatment-naive, poor performance status patients with non-small-cell lung cancer and epidermal growth factor receptor mutation. J Clin Oncol 2009; 27:1350-4. [PMID: 19224840 DOI: 10.1200/jco.2008.20.4859] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
18
|
Hesketh PJ, Chansky K, Wozniak AJ, Hirsch FR, Spreafico A, Moon J, Mack PC, Marchello BT, Franklin WA, Crowley JJ, Gandara DR. Southwest Oncology Group phase II trial (S0341) of erlotinib (OSI-774) in patients with advanced non-small cell lung cancer and a performance status of 2. J Thorac Oncol 2008; 3:1026-31. [PMID: 18758306 PMCID: PMC3523698 DOI: 10.1097/jto.0b013e318183aa1f] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This phase II study (S0341) evaluated the efficacy and tolerability of single-agent erlotinib in unselected chemotherapy-naive patients with advanced non-small cell lung cancer (NSCLC) and a performance status (PS) of 2. Exploratory analyses of a number of biomarkers relating to epidermal growth factor receptor pathway activation were also performed. PATIENTS AND METHODS Patients with stage IIIB (pleural effusion) or stage IV NSCLC with a PS of 2 and no prior chemotherapy or biologic treatment for NSCLC received erlotinib 150 mg daily. RESULTS A total of 81 patients entered the study; 76 were assessable. One complete and 5 partial responses were noted for an overall response rate of 8% (95% CI 3%-16%). Stable disease (SD) was seen in 26 patients (34%) resulting in a disease control rate (DCR = CR/PR/SD) of 42%. Progression free and median survival were 2.1 months (95% CI 1.5-3.1) and 5 months (95% CI 3.6-7.2), respectively. One-year survival was 24% (95% CI 15%-34%). Although treatment was generally well tolerated, grade 3 to 4 toxicity was reported in 30 patients (40%), including fatigue (16%), rash (9%), diarrhea (7%), and anorexia (7%). There was one possible treatment related death (pneumonitis). CONCLUSIONS In chemotherapy-naive patients with advanced NSCLC and a PS of 2, single agent erlotinib resulted in an acceptable but significant level of treatment-related side effects. With an overall DCR of 42% and median survival of 5 months, results are comparable to those achieved with chemotherapy in this population. Development of an epidermal growth factor receptor-directed biomarker selection strategy may optimize use of erlotinib in PS 2 patients.
Collapse
Affiliation(s)
- Paul J. Hesketh
- Caritas St. Elizabeth’s Medical Center of Boston, Boston, MA
| | - Kari Chansky
- Southwest Oncology Group Statistical Center, Seattle, WA
| | | | | | | | - James Moon
- Southwest Oncology Group Statistical Center, Seattle, WA
| | | | | | | | | | | |
Collapse
|
19
|
Vázquez S, Huidobro G, Amenedo M, Fírvida JL, León L, Lázaro M, Grande C, Mel JR, Ramos M, Salgado M, Casal J. Biweekly administration of docetaxel and vinorelbine as second-line chemotherapy for patients with stage IIIB and IV non-small cell lung cancer: a phase II study of the Galician Lung Cancer Group (GGCP 013-02). Anticancer Drugs 2007; 18:1201-6. [PMID: 17893521 DOI: 10.1097/cad.0b013e328273bbce] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The current report aims to evaluate the efficacy and safety profile of a biweekly administration of docetaxel and vinorelbine to patients with advanced non-small cell lung cancer, who had previously been treated for this disease. In a prospective, multicenter, open-label, phase II trial, patients received 40 mg/m of docetaxel and 20 mg/m of vinorelbine on days 1 and 15, every 28 days. Treatment continued for up to a maximum of six cycles, unless disease progression or unacceptable toxicity occurred, or consent was withdrawn. Fifty patients were enrolled in the study and they received 174 cycles of chemotherapy, with a median of three cycles per patient. All patients were evaluated for efficacy and toxicity in an intention-to-treat analysis. The overall response rate was 10% [95% confidence interval (CI): 1-19], including one complete response (2%) and four partial responses (8%). Previous chemotherapy of 80% of the responders included paclitaxel. Median time to disease progression was 2.7 months (95% CI: 2.2-4.3) and median overall survival was 6.5 months (95% CI: 2.5-9.2). The survival rates at 1 and 2 years were 18% (95% CI: 7-29) and 4% (95% CI: 0-10), respectively. The most frequent severe toxicities were neutropenia (20% of patients) and leukopenia (8% of patients). Other toxicities appeared in 4% or fewer of the patients. Biweekly administration of docetaxel and vinorelbine is feasible as a second-line treatment for non-small cell lung cancer patients, but its level of activity and toxicity does not suggest any advantage compared with the results obtained with single-agent docetaxel in the same setting.
Collapse
|
20
|
Le Lay K, Myon E, Hill S, Riou-Franca L, Scott D, Sidhu M, Dunlop D, Launois R. Comparative cost-minimisation of oral and intravenous chemotherapy for first-line treatment of non-small cell lung cancer in the UK NHS system. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2007; 8:145-51. [PMID: 17333088 DOI: 10.1007/s10198-006-0034-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 12/14/2006] [Indexed: 05/14/2023]
Abstract
The National Institute for Health and Clinical Excellence recommends vinorelbine (VNB), paclitaxel, docetaxel, and gemcitabine in the treatment of non-small cell lung cancer. An economic model was prepared to determine the comparative cost of these agents, including the new oral formulation of VNB from a United Kingdom National Health System perspective. Clinical effectiveness was determined from published trials. Costs of drug acquisition, administration, toxicity management, and patient transportation costs were calculated from reference publications. A Markov model was used to estimate the cost per patient over 52 weeks. Intravenous VNB, gemcitabine, paclitaxel, and docetaxel incur annual follow-up costs of 3,746 pounds, 5,332 pounds, 5,977 pounds, and 6,766 pounds, respectively, while oral VNB with outpatient administration on d1, and self-administration at home on d8 every 21 days has a cost per patient per year of 2,888 pounds. Oral VNB allows further hospital resources savings.
Collapse
Affiliation(s)
- K Le Lay
- REES France, 28 rue d'Assas, 75 006, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Langer C, Li S, Schiller J, Tester W, Rapoport BL, Johnson DH. Randomized phase II trial of paclitaxel plus carboplatin or gemcitabine plus cisplatin in Eastern Cooperative Oncology Group performance status 2 non-small-cell lung cancer patients: ECOG 1599. J Clin Oncol 2007; 25:418-23. [PMID: 17264337 DOI: 10.1200/jco.2005.04.9452] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Appropriate therapy for Eastern Cooperative Oncology Group (ECOG) performance status (PS) -2 patients with advanced non-small-cell lung cancer (NSCLC) remains challenging. PS-2 patients on ECOG 1594 had a median survival (MS) of only 4.1 months and 1-year overall survival (OS) of 19%. Three percent had grade 5 toxicity. PATIENTS AND METHODS ECOG 1599, the first PS 2-specific, US cooperative group trial for treatment-naïve advanced NSCLC, randomly assigned patients to dose-attenuated carboplatin/paclitaxel (the least toxic regimen in ECOG 1594) or gemcitabine/cisplatin (which yielded an MS of 7.9 months in PS-2 patients). Patients received either carboplatin (area under the concentration-time curve, 6) and paclitaxel 200 mg/m2 every 3 weeks (CbP) or gemcitabine 1 g/m2 days 1 and 8 and cisplatin 60 mg/m2 day 1 every 3 weeks (CG). RESULTS One hundred three patients were enrolled; 100 proved eligible. Median age was 66 years; 46% had at least 5% weight loss; 88% had stage IV or recurrent disease. Median number of cycles administered was three per arm. CbP featured more grade 3 neutropathy (10% v 0%) and more grade > or = 3 neutropenia (59% v 33%), whereas CG yielded more grade 3 thrombocytopenia (33% v 14%), more grade 3 fatigue (22% v 14%), and more grade > or = 1 creatinine elevations (43% v 6%). One grade 5 toxicity, confined to the CbP arm, occurred. Response rate, time to progression, MS, and 1-year OS rates for CG and CbP, were 23%, 4.8 months, 6.9 months, and 25%, and 14%, 4.2 months, 6.2 months, and 19%, respectively. CONCLUSION Platinum-based combination chemotherapy for PS-2 patients with NSCLC is feasible with acceptable toxicity, but survival in these patients remains inferior to that of PS-0 to -1 patients.
Collapse
Affiliation(s)
- Corey Langer
- Thoracic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Hauser CA, Stockler MR, Tattersall MHN. Prognostic factors in patients with recently diagnosed incurable cancer: a systematic review. Support Care Cancer 2006; 14:999-1011. [PMID: 16708213 DOI: 10.1007/s00520-006-0079-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 04/12/2006] [Indexed: 11/26/2022]
Abstract
GOALS OF WORK To review the literature and develop a conceptual framework about prognostic factors for people presenting to medical oncologists with recently diagnosed incurable cancer. MATERIALS AND METHODS Medline was searched from January 2000 to October 2003 to identify articles testing associations between clinical or laboratory variables and survival time in adults with advanced solid tumours and median survival of 3 to 24 months. We recorded how frequently prognostic factors were significantly associated with survival in univariable and multivariable analyses. RESULTS There were 53 studies included. The factors associated with survival were organised into four categories related to attributes of the host the tumour, the treatment and the interactions between host, tumour and treatment (symptoms, quality of life, performance status and laboratory tests). Co-morbidity was consistently associated with shorter survival. Age and gender were not consistently associated with survival duration, except in lung cancer where females survived longer. Tumour-related factors associated with shorter survival included primary tumour (lung), metastatic site (liver, brain and visceral) and disease extent. Symptoms associated with shorter survival included those of the anorexia-cachexia syndrome, dyspnoea, pain and impaired physical well being. Performance status was strongly associated with survival in most studies. Laboratory tests associated with shorter survival included anaemia, thrombocytopenia, hypoalbuminaemia and elevated serum levels of both alkaline phosphatase and lactate dehydrogenase. CONCLUSION Prognostic factors in patients with advanced cancer can be conceptualised as attributes of the host, tumour, treatment and interactions between the three reflected in symptoms, quality of life performance status and laboratory tests.
Collapse
Affiliation(s)
- Catherine A Hauser
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia
| | | | | |
Collapse
|
23
|
Samlowski WE, Leachman SA, Wade M, Cassidy P, Porter-Gill P, Busby L, Wheeler R, Boucher K, Fitzpatrick F, Jones DA, Karpf AR. Evaluation of a 7-Day Continuous Intravenous Infusion of Decitabine: Inhibition of Promoter-Specific and Global Genomic DNA Methylation. J Clin Oncol 2005; 23:3897-905. [PMID: 15753459 DOI: 10.1200/jco.2005.06.118] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PurposeThe nucleoside analog 5-aza-2′-deoxycytidine (5-aza-CdR, decitabine) is a potent inhibitor of DNA methylation in vitro. Cellular treatment with this agent induces the re-expression of methylation-silenced genes. It remains unclear to what extent this compound inhibits DNA methylation in vivo. A clinical study was designed to examine the molecular effects and toxicity of a continuous 1-week intravenous infusion of decitabine in solid tumor patients.MethodsTen patients with refractory solid tumors were included in this study. Decitabine was administered at 2 mg/m2/d via continuous infusion for 168 hours. Quantitative polymerase chain reaction and high performance liquid chromatography were utilized to measure promoter-specific and global DNA methylation in peripheral-blood cells before and after treatment.ResultsTransient grade III/IV neutropenia (two patients) and grade II thrombocytopenia (one patient) was observed at the lowest planned dose step (2 mg/m2/d for 7 days). Nonhematologic toxicities were not observed. Quantitative polymerase chain reaction demonstrated significant MAGE-1 promoter hypomethylation by 14 days after the start of treatment in all 13 treatment cycles examined. Significant genomic DNA hypomethylation was also seen by day 14 in 11 of 13 treatment cycles analyzed. Genomic DNA methylation reverted to baseline levels by 28 to 35 days after the start of treatment, demonstrating that inhibition of DNA methylation by decitabine is transient.ConclusionA 168-hour continuous infusion of decitabine is well tolerated and results in the inhibition of promoter-specific and genomic DNA methylation in vivo. This treatment schedule is suitable for evaluation of decitabine in combination with agents whose activity may be enhanced by the reversal of DNA methylation–mediated gene silencing.
Collapse
Affiliation(s)
- Wolfram E Samlowski
- Huntsman Cancer Institute and the Department of Internal Medicine (Oncology), University of Utah, Salt Lake City, UT 84112-5550, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Kwok Y, Regine WF, Patchell RA. Radiation Therapy Alone for Spinal Cord Compression: Time to Improve Upon a Relatively Ineffective Status Quo. J Clin Oncol 2005; 23:3308-10. [PMID: 15738546 DOI: 10.1200/jco.2005.11.940] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
25
|
Hu Y, Bebb G, Tan S, Ng R, Yan H, Sartor JR, Mayer LD, Bally MB. Antitumor efficacy of oblimersen Bcl-2 antisense oligonucleotide alone and in combination with vinorelbine in xenograft models of human non-small cell lung cancer. Clin Cancer Res 2005; 10:7662-70. [PMID: 15569999 DOI: 10.1158/1078-0432.ccr-04-1036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Overexpression of Bcl-2 protein in cancer cells can inhibit programmed cell death and engender chemoresistance. Reducing Bcl-2 protein levels by using antisense oligonucleotides targeting the gene message can increase the sensitivity of cancer cells to cytotoxic agents. The objective of this work was to investigate the antitumor efficacy of the Bcl-2 antisense oligonucleotide oblimersen (Genasense; G3139), alone and in combination with vinorelbine (VNB), in an ectopic and orthotopic xenograft model of NCI-H460 human non-small-cell lung cancer. In addition to assessing therapeutic effect, Bcl-2 protein expression in tumor tissue isolated from lung and heart was measured. In the ectopic xenograft model, oblimersen at 5 and 10 mg/kg significantly inhibited tumor growth compared with saline-treated control groups, and furthermore, the antitumor effect of oblimersen was associated with down-regulation of Bcl-2 protein in isolated tumor tissue. Moreover, the combination of oblimersen with VNB was more active in inhibiting tumor growth than either drug used alone. In the orthotopic model, oblimersen treatment (5 mg/kg) increased the median survival time of mice to 33 days in comparison with a median survival time of 21 days in the control animals. With this model, the anticancer effect was demonstrated by assessing tumor growth in lung and heart tissues by hematoxylin and eosin staining and Bcl-2 expression by immunohistochemistry. When VNB at 5 mg/kg was combined with oblimersen administered at 5 mg/kg, 33% of mice survived more than 90 days. These data suggest that the combination of oblimersen and VNB may provide enhanced antitumor activities against non-small-cell lung cancer.
Collapse
Affiliation(s)
- YanPing Hu
- Genzyme Corporation, Framingham, Massachusetts, USA
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Okamoto T, Maruyama R, Shoji F, Asoh H, Ikeda J, Miyamoto T, Nakamura T, Miyake T, Ichinose Y. Long-term survivors in stage IV non-small cell lung cancer. Lung Cancer 2005; 47:85-91. [PMID: 15603858 DOI: 10.1016/j.lungcan.2004.06.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 06/18/2004] [Accepted: 06/21/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine the prognostic factors for long-term survivors (LTS) with stage IV non-small cell lung cancer (NSCLC) who had undergone various treatments. PATIENTS AND METHODS From 1990 to 1999, 222 NSCLC patients with stage IV disease, who had been treated in our department, were reviewed. As the initial treatment, 135 patients (48%) were treated with chemotherapy alone, 52 patients with a combination of chemotherapy and radiotherapy, 19 patients underwent an operation with or without any other therapeutic modalities and 16 were received radiotherapy alone. RESULTS Seventeen (7.7%) patients survived for more than 2 years, and all but one had adenocarcinoma. Among these LTS, eight patients received surgery as the initial therapy, and 16 (94.1%) received some type of local-control therapy, including surgery or radiotherapy, during the course of their disease. Regarding the clinical characteristics between LTS and others (non-LTS), an early N status, a single metastatic site, a good performance status, and surgery for initial therapy were all found to be significantly important factors for LTS. A multivariate analysis using a logistic regression model also showed an early N status and surgical treatment to be significantly associated with LTS. CONCLUSIONS Selected patients with an early N status may be appropriate candidates for aggressive multimodality treatment including surgery, in order to provide a long-term survival for stage IV NSCLC.
Collapse
Affiliation(s)
- Tatsuro Okamoto
- Department of Thoracic Oncology, National Kyushu Cancer Center, 3-1-1, Notame, Minami-ku, Fukuoka 811-1395, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Zinner RG, Herbst RS. Pemetrexed in the treatment of advanced non-small-cell lung cancer: a review of the clinical data. Clin Lung Cancer 2004; 5 Suppl 2:S67-74. [PMID: 15117428 DOI: 10.3816/clc.2004.s.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pemetrexed is a novel multitargeting antimetabolite that has first-line and second-line activity against non-small cell lung cancer (NSCLC). Phase II studies have shown significant efficacy and a favorable toxicity profile of the combination of pemetrexed plus platinum as first-line therapy for NSCLC. Second-line activity against NSCLC was demonstrated in a phase III trial comparing single-agent pemetrexed with docetaxel; in that trial, survival was comparable between these agents but side effects were significantly less for patients who received pemetrexed. Pemetrexed is also an active agent against mesothelioma. A phase III trial comparing pemetrexed plus cisplatin with cisplatin alone showed for the first time a regimen that improves survival in this disease and led to FDA approval of pemetrexed in combination with cisplatin for mesothelioma. As a radiosensitizer, pemetrexed has been well-tolerated when given concurrent with chest radiation, and a phase I study is under way assessing its tolerability in combination with carboplatin in this setting. Pemetrexed is clearly a useful agent in the treatment of thoracic malignancies, and is worthy of further study in combination with other drugs having novel mechanisms of action.
Collapse
Affiliation(s)
- Ralph G Zinner
- Department of Thoracic/Head & Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.
| | | |
Collapse
|
29
|
Abstract
Since cisplatin-based chemotherapy was proven to increase survival in advanced and metastatic NSCLC various new combinations have been tested. The third generation regimens which showed almost comparable efficacy among each other in randomised trials often proved a better response rate and time to progression combined with a remarkable reduction of toxic side effects compared to "classic" combinations, whereas most studies only noted a modest increase in survival. Two-drug regimens were more effective than monotherapy but at the expense of significantly increased toxicity, while monotherapy compared to BSC improved quality of life and survival. The novel antifolate Pemetrexed proved comparable activity to docetaxel with significantly reduced toxicities.
Collapse
Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Hospital Grosshansdorf, Center of Pneumology and Thoracic Surgery, Woehrendamm 80, D-22927 Grosshansdorf, Germany.
| | | |
Collapse
|
30
|
Pappagallo GL. La Chemioterapia Del Carcinoma Polmonare a Cellule Non Piccole in Fase Avanzata. Dall'uso esclusivo della “P” all'interpretazione quantitativo-probabilistica dei dati metanalitici. TUMORI JOURNAL 2004; 90:28-43. [PMID: 15510995 DOI: 10.1177/030089160409000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giovanni L Pappagallo
- Ufficio di Epidemiologia e Sperimentazioni Cliniche, Dipartimento di Oncologia ed Ematologia Oncologica, Ospedale PF Calvi, Noale, VE
| |
Collapse
|
31
|
Ohe Y, Niho S, Kakinuma R, Kubota K, Ohmatsu H, Goto K, Nokihara H, Kunitoh H, Saijo N, Aono H, Watanabe K, Tango M, Yokoyama A, Nishiwaki Y. A phase II study of cisplatin and docetaxel administered as three consecutive weekly infusions for advanced non-small-cell lung cancer in elderly patients. Ann Oncol 2004; 15:45-50. [PMID: 14679118 DOI: 10.1093/annonc/mdh015] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of treatments for advanced non-small-cell lung cancer in elderly patients aged 75 years or older, we conducted a phase II study of cisplatin and docetaxel administered in three consecutive weekly infusions. PATIENTS AND METHODS The eligibility criteria for the study included the presence of chemotherapy-naive advanced non-small-cell lung cancer, age > or =75 years, Eastern Cooperative Oncology Group performance status of 0 or 1, a measurable lesion, adequate organ functions and signed informed consent. The chemotherapy regimen consisted of cisplatin (25 mg/m(2)) and docetaxel (20 mg/m(2)) on days 1, 8 and 15 every 4 weeks. RESULTS Between February 2000 and March 2002, 34 elderly patients with non-small-cell lung cancer were enrolled in the study and 33 patients were treated. Two complete responses and 15 partial responses were obtained for an objective response rate of 52% in 33 treated patients. The median survival period was 15.8 months, and the 1-year survival rate was 64%. Toxicities were mild with no grade 4 toxicities. Only grade 3 leukopenia (6%), neutropenia (12%), anemia (3%), hyponatremia (3%) and nausea/vomiting (3%) were observed. CONCLUSION Cisplatin and docetaxel administered in three consecutive weekly infusions was safe and effective for the treatment of elderly patients with chemotherapy-naive non-small-cell lung cancer.
Collapse
Affiliation(s)
- Y Ohe
- Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Lilenbaum R. Management of Advanced Non–Small-Cell Lung Cancer in Patients with a Performance Status of 2. Clin Lung Cancer 2004; 5:209-13. [PMID: 14967072 DOI: 10.3816/clc.2004.n.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with a poor performance status (PS) constitute a substantial fraction of patients with advanced non-small-cell lung cancer (NSCLC), yet these patients have been largely excluded from clinical research in the past decade. Despite the proven benefits of chemotherapy in patients with a good PS, cooperative group trials in the 1980s showed that patients with a PS of 2 did not benefit from chemotherapy and, in fact, had high rates of morbidity and mortality, a notion that came to dominate clinical practice for the next 2 decades. More recent studies demonstrate that these patients indeed have a worse prognosis than those with a better PS. However, chemotherapy seems to provide a benefit, at least in terms of symptom improvement, and may improve survival as well. A recent comparison of single-agent therapy with combination chemotherapy showed an advantage for patients with a PS of 2 treated with the combination regimen, without a detriment to quality of life. Dedicated studies in patients with a PS of 2 are urgently needed. More effective chemotherapy and better supportive care may allow extension of benefits of chemotherapy in advanced NSCLC to patients with a PS of 2. Ongoing trials are in progress to further test the role of molecular-targeted agents alone or in combination with standard chemotherapeutic agents in this subset of patients.
Collapse
Affiliation(s)
- Rogerio Lilenbaum
- Thoracic Oncology Program, Mount Sinai Comprehensive Cancer Center, Miami Beach, FL 33140-2840, USA.
| |
Collapse
|
33
|
Pfister DG, Johnson DH, Azzoli CG, Sause W, Smith TJ, Baker S, Olak J, Stover D, Strawn JR, Turrisi AT, Somerfield MR. American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: update 2003. J Clin Oncol 2003; 22:330-53. [PMID: 14691125 DOI: 10.1200/jco.2004.09.053] [Citation(s) in RCA: 1099] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- David G Pfister
- American Society of Clinical Oncology, Cancer Policy and Clinical Affairs, 1900 Duke St, Suite 200, Alexandria, VA 22314, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Wachters FM, van Putten JWG, Kramer H, Erjavec Z, Eppinga P, Strijbos JH, de Leede GPJ, Boezen HM, de Vries EGE, Groen HJM. First-line gemcitabine with cisplatin or epirubicin in advanced non-small-cell lung cancer: a phase III trial. Br J Cancer 2003; 89:1192-9. [PMID: 14520444 PMCID: PMC2394313 DOI: 10.1038/sj.bjc.6601283] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of our study was to compare progression-free survival and quality of life (QOL) after cisplatin–gemcitabine (CG) or epirubicin–gemcitabine (EG) in chemotherapy-naive patients with unresectable non-small-cell lung cancer. Patients (n=240) were randomised to receive gemcitabine 1125 mg m−2 (days 1 and 8) plus either cisplatin 80 mg m−2 (day 2) or epirubicin 100 mg m−2 (day 1) every 3 weeks for a maximum of five cycles. Eligible patients had normal organ functions and Eastern Cooperative Oncology Group performance status ⩽2. QOL was measured with European Organisation for Research and Treatment of Cancer QLQ-C30 and LC13 questionnaires. There were no significant differences in median progression-free survival (CG 26 weeks, EG 23 weeks), median overall survival (CG 43 weeks, EG 36 weeks), or tumour response rates (CG 46%, EG 36%). Toxicity was mainly haematologic. In the EG arm granulocytopenia occurred more frequently, leading to more febrile neutropenia. Also, elevation of serum transaminases, mucositis, fever, and decline in LVEF were more common in the EG arm. In the CG arm, more patients experienced elevated serum creatinine levels, sensory neuropathy, nausea, and vomiting. Global QOL was not different in both arms. Progression-free survival, overall survival, response rate, and QOL were not different between both arms; however, overall toxicity was more severe in the EG arm.
Collapse
Affiliation(s)
- F M Wachters
- Department of Pulmonary Diseases, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - J W G van Putten
- Department of Pulmonary Diseases, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - H Kramer
- Department of Pulmonary Diseases, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Z Erjavec
- Department of Internal Medicine, Delfzicht Hospital, Jachtlaan 50, 9934 JD Delfzijl, The Netherlands
| | - P Eppinga
- Department of Pulmonary Diseases, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN Drachten, The Netherlands
| | - J H Strijbos
- Department of Pulmonary Diseases, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN Drachten, The Netherlands
| | - G P J de Leede
- Department of Pulmonary Diseases, Bethesda Hospital, Amshoffweg 1, 7909 AA Hoogeveen, The Netherlands
| | - H M Boezen
- Department of Epidemiology and Statistics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - H J M Groen
- Department of Pulmonary Diseases, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
- Department of Pulmonary Diseases, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. E-mail:
| |
Collapse
|
35
|
Kosmidis PA. In Reply:. J Clin Oncol 2003. [DOI: 10.1200/jco.2003.99.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
36
|
Zinner R. Treatment of Patients with Advanced Non-Small Cell Lung Cancer. Lung Cancer 2003. [DOI: 10.1007/0-387-22652-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
37
|
Waters JS, O'Brien MER. The case for the introduction of new chemotherapy agents in the treatment of advanced non small cell lung cancer in the wake of the findings of The National Institute of Clinical Excellence (NICE). Br J Cancer 2002; 87:481-90. [PMID: 12189541 PMCID: PMC2376159 DOI: 10.1038/sj.bjc.6600491] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2002] [Revised: 04/15/2002] [Accepted: 05/19/2002] [Indexed: 11/23/2022] Open
Abstract
After years of nihilism towards the use of chemotherapy for non small cell lung cancer in the UK it would appear that we have now reached the point where the use of chemotherapy to relieve symptoms, maintain quality of life, and prolong life, are now accepted for informed patients with good performance status willing to accept short-term toxicities. The use of the new agents vinorelbine, gemcitabine and paclitaxel in combination with cisplatin or carboplatin are all active regimens which offer small but real advantages over standard UK triple therapies (MVP, MIC) in terms of resource use, toxicity profiles and response rates. Overall survival could be increased by as much as 10% at one year on indirect comparisons. The use of docetaxel as second line therapy now offers lung cancer patients a second bite of the cherry, and should overall also prolong survival. It is only in embracing these small gains that we can currently make progress in the treatment of NSCLC.
Collapse
Affiliation(s)
- J S Waters
- Lung Unit, The Royal Marsden Hospital, Sutton, Surrey, UK
| | | |
Collapse
|
38
|
Grigorescu AC, Draghici IN, Nitipir C, Gutulescu N, Corlan E. Gemcitabine (GEM) and carboplatin (CBDCA) versus cisplatin (CDDP) and vinblastine (VLB) in advanced non-small-cell lung cancer (NSCLC) stages III and IV: a phase III randomised trial. Lung Cancer 2002; 37:9-14. [PMID: 12057861 DOI: 10.1016/s0169-5002(01)00493-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The combination of Gemcitabine (GEM)/carboplatin (CBDCA) has demonstrated activity in the treatment of stage III and IV non-small-cell lung cancer (NSCLC). This phase III randomized trial compared the response rate, survival rate, and toxicity of the combination of GEM plus CBDCA with the combination of VLB plus CDDP. METHODS Chemonaïve patients with advanced or metastatic NSCLC were enrolled in the study. Pts were randomized by coin method to receive either cisplatin (CDDP) 70 mg/m(2) on day 1 plus vinblastine (VLB) 6 mg/m(2) on days 1 and 8 (arm A) or gemcitabine 1000 mg/m(2) on days 1 and 8 plus carboplatin 300 mg/m(2) on day 1 (arm B). Both regimens were administered on a 21-day course. RESULTS A total of 198 patients (99 pts each in arms A and B) were enrolled in the study between July 1997 and April 2000. All pts had an ECOG performance status < or=2. Patients had a median age of 58 years (range, 49-67) in arm A and 59 years (range, 49-69) in arm B. In arm A, there were 15 partial responders (PR), for an overall response rate (ORR) of 15%, compared with three complete responders (CR) and 24 PR, for an ORR of 27% (P<0.05), in arm B. Mean survival times were 7.9 months (95% CI, 7.1-8.0) in arm A and 11.6 months (95% CI, 10.0-13.0) in arm B. One-year survival rates for arms A and B, respectively, were 13 and 36%. Numbers of pts with WHO grad 3/4 hematologic and non-hematologic toxicity in arms A/B were leukopenia 0/2, thrombocytopenia 0/2, alopecia 46/33, neurotoxicity 2/1, and asthenia 35/42. CONCLUSION The GEM/CBDCA combination showed a higher therapeutic response, an improved 1-year survival, and a similar toxicity profile compared with the VLB/CDDP combination.
Collapse
Affiliation(s)
- Alexandru C Grigorescu
- Department of Medical Oncology, Institute of Oncology Bucharest, Fundeni Street no. 252, Sectr. II, Bucharest, Romania.
| | | | | | | | | |
Collapse
|
39
|
Booton R, Thatcher N. Chemotherapy in advanced nonsmall cell lung cancer: indication, intensity, and duration. Curr Opin Oncol 2002; 14:191-8. [PMID: 11880710 DOI: 10.1097/00001622-200203000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Platinum-based combination and single-agent chemotherapy have become accepted as treatments for locally advanced and metastatic nonsmall cell lung cancer as a consequence of improved survival, quality of life, and symptom control compared with best supportive care. However, it is clear that a therapeutic plateau has been reached with current combinations requiring a re-evaluation of strategies to improve clinical outcomes. Dose intensification may offer one way in which to achieve better results, as may extension of the duration of treatment. The evidence suggests that dose intensification is a useful tool, and that its use in combination with markers of treatment duration and cumulative dose may help to maximize results from current active drug combinations.
Collapse
Affiliation(s)
- Richard Booton
- CRC Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, United Kingdom
| | | |
Collapse
|
40
|
Aapro MS, Harper P, Johnson SA, Vermorken JB. Developments in cytotoxic chemotherapy: advances in treatment utilising vinorelbine. Crit Rev Oncol Hematol 2001; 40:251-63. [PMID: 11738948 DOI: 10.1016/s1040-8428(01)00167-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Vinorelbine is a third generation vinca alkaloid which has been in clinical development for 15 years. Recent exploration of its pre-clinical activity has revealed unexpected evidence of potential synergy with taxane compounds and early clinical results support the suggestion of enhanced efficacy particularly in breast cancer. The initial studies establishing the clinical activity of vinorelbine in breast cancer and non-small cell lung cancer have been extended to encompass a thorough evaluation of its contribution to combination chemotherapy for these disorders. In the treatment of breast cancer useful activity has been established for vinorelbine in combination with anthracyclines, anthracenediones, antimetabolites and the taxanes; additive toxicity is not a limiting factor. The activity of vinorelbine in the treatment of non-small cell lung cancer is significantly extended by incorporation into schedules utilising cisplatin and other agents. Vinorelbine has also demonstrated useful activity in the treatment of a wide range of other malignancies including prostatic carcinoma, multiple myeloma, cancer of the ovary, cervix and head and neck and malignant lymphomas.
Collapse
Affiliation(s)
- M S Aapro
- Clinique de Genolier, 1272 Genolier, Switzerland
| | | | | | | |
Collapse
|
41
|
Affiliation(s)
- G Giaccone
- Vrije Universiteit Amsterdam, Department of Medical Oncology, The Netherlands
| |
Collapse
|
42
|
Abstract
Despite unequivocal evidence of activity and tolerability, the potential contribution of vinorelbine to the management of non-small cell lung cancer (NSCLC) has been relatively unappreciated. A phase III trial of vinorelbine as a single agent in the elderly demonstrated clear benefits in terms of survival and quality of life compared with supportive care. Two other phase III trials demonstrated that vinorelbine plus platinum was superior when compared either with one of the older platinum combinations, platinum as a single agent or vinorelbine alone. New vinorelbine-based regimens appear to be active but with less toxicity than older combinations in stage IV disease. Chemotherapy plays an essential role in the management of locally advanced (i.e., stage III) disease with the weight of evidence supporting improved curability of this stage when drugs are employed either preoperatively or as part of a chemoradiotherapy regimen. It has been reported that induction therapy using carboplatin/vinorelbine or carboplatin/paclitaxel followed by accelerated conformal radiation therapy has promising results without causing undue toxicity. Clearly, vinorelbine is an active agent which is well tolerated and suitable for use in the management of NSCLC. It is likely to play a greater role in the future.
Collapse
Affiliation(s)
- M J Edelman
- University of Maryland, Greenebaum Cancer Center, Baltimore, Maryland 21201-1595, USA.
| |
Collapse
|